Annals Q&A With Dr. Jonny Kim

Abstract

Jonny Kim, MD, Former Navy SEAL and recipient of both the Silver Star and Bronze Star, was a first-year resident physician at the Harvard-associated emergency medicine residency program in Boston when he received an invitation to join the 2017 incoming class of NASA astronauts. It had started with an application submitted on USAjobs.gov. Eventually, Kim emerged from a field of more than 18,000 applicants competing for only 12 positions. He endured 2 rounds of callbacks consisting of 9 days of tests, interviews, and screenings. He reported for duty at Johnson Space Center in Houston, TX, on August 21, 2017. We met during his final days as an emergency medicine resident. Our conversation began with a description of the selection process. JK: They perform mental tests, ECGs, blood draws, chest radiograph, typical medical tests. You do a multiple-choice personality and behavioral test. Then, of course, is an interview with the selection board. I can’t go into specific questions they ask. At the second interview, there were longer interviews with behavioral specialists and a lot of challenging, team-oriented games, where you have to work closely in small teams and use the resources you’re given to complete the objective. The entire time, you’re being evaluated. I think they are looking for how you react to stress and interactions with your team members, all of whom I had never met before. Annals: Many kids say, “When I grow up, I want to be a baseball player or an astronaut.” Were you one of those, and when did you start thinking, “Wait a minute, like, this isn’t crazy; this is actually an attainable goal”? JK: I had a really blessed and circuitous route to get where I am today. I was the epitome of that quiet kid who just lacked complete self-confidence. I was used to getting picked last on the baseball and basketball team. High school was a complete nightmare for me. [laughs] I never showed up for my yearbook picture. I didn’t go to prom. I was scared of a lot of things. And a lot of that was childhood hardships I was going through at the time. But as a kid, I did not have really any dreams until I was 16 years old and I heard about Naval Special Warfare and the kinds of things that Naval Special Warfare operators do. And that was really the first time, when I was 16, that I actually had a vision, and a dream, and felt that I was called to do something. So I never once thought I could be a physician, or an astronaut, or anything else. No one believed in me and I didn’t believe in myself very much. But I was very drawn to the Naval Special Warfare. And I drove myself, in high school, to train my body to be able to go through that kind of training. I graduated from high school. And I was a good student. I just didn’t have the drive to go to an academic institution after high school. I knew that was not a calling for me. So I went into the Navy. And I was able to go into Naval Special Warfare and serve in that capacity, which was a very growing experience for me. It helped me find my identity. It helped build my confidence to what I have today. And it helped me see challenges for what they are and be able to draw off the strength to overcome. Going into the Navy was the best decision I ever made in my life because it completely transformed that scared boy who didn’t have any dreams to someone who started to believe in himself. From my wartime experiences, I had the fortunate opportunity to provide medical aid to a lot of people who needed it; specifically, my teammates who were shot or blown up. And there were some spectacular emergency physicians, surgeons, nurses, who saved a lot of my friends’ lives and their limbs. And I was very appreciative of that. That painted my future and led me to being a physician. Annals: This was Iraq, right? JK: Yeah. After the war, I went to college. I was already in my mid to late twenties when I started undergraduate and got my degree in math. And then I went to medical school, here at Harvard. It was during medical school when I thought about NASA for the first time as an adult. I met an astronaut named Scott Parazynski who was also a physician, training in emergency medicine, and who had been called to NASA a couple months shy of finishing his residency actually. [laughs] He’s an amazing individual. And he opened up my eyes to NASA and its mission. Like the mission statement of Naval Special Warfare, it really struck a chord with me, of going to the unknown of space and overcoming these impossible challenges, with technology we had not yet developed, with a small team. And the excitement, the adventure of exploring the unknown really hit home for me—but, more important, so did the idea that I would have a chance to inspire young children, who may be in tough situations as kids, who may not have the confidence or the big dreams to believe in themselves and do something big. That’s the most important part, for me. It’s consistent with what I want to do in life, which is to leave something good and positive and help people, the same reasons I went to medicine. Annals: How many physicians have been in space and how many emergency medicine–trained physicians? JK: A decent number of physicians have gone to space. Story Musgrave is a physician and former astronaut, as are Scott Parazynski and Jim Bagian. Active physician astronauts include Drew Morgan, Kjell Lindgren, Tom Marshburn, Serena Aunon-Chancellor, and Michael Barratt. Drs. Morgan, Lindgren, and Marshburn are emergency physicians. One of my NASA classmates, Dr. Frank Rubio, is a family practice physician and a former helicopter pilot. Emergency medicine does seem to be more popular in the astronaut corps. There have also been surgeons like Dr. Robert Satcher. Annals: Do you think that NASA could go to Mars without an emergency physician on board? JK: It seems like you would want someone with varied experiences and definitely someone who has at least some background in basic medical skills. I don’t know what specialty would be most appropriate for a mission to Mars, but I definitely think someone with a background in medicine. Annals: You graduated from medical school. You spent a year at one of the finest emergency medicine training programs. But I think of Luke Skywalker in Star Wars. It’s like, you know, “Your training is not yet complete—” JK: [laughs] Annals: “—and it’s a dangerous time.” Does NASA understand that? Do they expect someone like you to practice medicine in space? JK: It’s hard to speak to why NASA selected me or exactly what they’re looking for. I can’t speak for NASA if there’s a possibility I will continue my medical training. I’m just saying that I would be personally and professionally interested. Annals: Was there any sense of, “Wait. Why don’t you just wait a couple years?” JK: I couldn’t have foreseen getting selected. I mean, there are so many amazing people who apply for this job that I just couldn’t foresee it. Most people don’t get in on their first application. The application cycle is every 4 years on average. I have a lot of faith in the astronaut selection system. I think that I would have had a different set of skills, had I completed training. But, yeah, it’s hard for me to leave medicine. But for me at this time, it’s not a good-bye, but more of a pause. I need to navigate the terrain of how to be a great astronaut, how I can do the best I can, be a positive contributor at NASA, before I take another serious look at medicine. Annals: In the meantime, many people see you as representing emergency medicine. JK: Speaking on that, I always want to make sure I’m doing the best job I can for people. And I personally hate letting people down. And it’s very humbling to be considered a representative for a field that I feel I have not contributed much to. I would be going into my postgraduate year 2 if I had stayed in my residency. And I recognize that. But yet I’m still going to be a representative of emergency medicine. I take that responsibility very seriously. And I hope that I can make people proud at home and do a great job. That also is another reason why I would like to finish training, to better represent not just the emergency medicine community but medicine as a whole. It’s a true honor and definitely feels undeserved—very humbling. Annals: Let’s talk space travel. Is the long-term radiation exposure kind of a deal breaker? With the technology as it is, is that a barrier that we can’t overcome? How do you feel about that risk? JK: From the technical perspective, I can’t answer that because I just don’t know what the barriers are to radiation exposure for a long-space-duration mission. I mean, if NASA determined some degree of radiation risk was necessary to make a trip to Mars, that certainly would fit within my risk profile. A lot of people make a lot of sacrifices for things. And if I can have a chance to leave a positive contribution, it’s a small risk to pay, in the end. I think maybe it also helps that I already have children [laughs], maybe. Annals: That helps? JK: Yeah. It’s not something that would stop me from a mission [to Mars].... And I think probably a lot of people in the astronaut corps would feel similar. I think it’s our job to minimize risk as much as possible but to recognize and respect that the risk is there and not to take any unnecessarily. So I will leave it to the engineers to solve that problem. But if the question is for my risk profile, then I’d certainly be ready. Annals: Emergency physicians think about constantly. This is macabre, but before the Challenger disaster, NASA staked the risk of a catastrophic failure at something like 1 in 10,000, 1 in 100,000. Of course, we know that the actual outcome was like 2 catastrophes out of 135, something like that. Is that something that you think about? That you might die up there? Is that something that bothers you or is that the price of admission? JK: NASA has proved itself as a great force in regard to learning from the past. Certainly from the Apollo 1 disaster, they were able to regroup and really redefine their mission and learn from that tragedy. And I think the same goes with the shuttle accidents. I have a lot of faith in NASA and our government and the fabulous scientists and engineers who work there. It’s important to recognize that there’s always an undefined risk, especially when we venture out into something that no one has done before, but that we respect that risk and we do everything we can to mitigate that. And I believe in that process. After all is said and done, I think the prospect of space exploration [is important]: what that can bring as far as a return on investment, to our technology, to people’s quality of lives, but, most important, having that chance to really inspire the next generation.... And it’s kind of hard to put a number value on how valuable that is. I think it’s worth the risk. Annals: What do you think is actually more dangerous, space flight or battle conditions? JK: Battle conditions encompass a spectrum of risk, depending on your training, equipment, and the resources you have; you know, if you have air support, and of course, what kind of environment you’re in. So it’s hard to quantify the level of risk in a battle condition because it’s a very wide spectrum. With space flight, I think it’s also hard to quantify. Annals: What are some of the issues of medical care that are different in zero-gravity environments? They’ve dealt with osteoporosis…. JK: Oh, yeah, and also orthostatic changes that occur. There are other focuses of research, including reports of optic disc edema associated with long-duration space flights. Annals: I’d like to address the potential mental health challenges of being in tight quarters with other human beings, who are flawed, as we all are. JK: I can’t comment on what it’s like, from a NASA perspective, to be in close quarters with other crewmates on a long space mission. But I can certainly comment on my own experiences from being in the Navy, being with a tight group of men and women, every day in battle conditions. I think that, if you have a great team, which I did have, you learn to leverage one another’s strengths and weaknesses. You learn to live with one another. For me, they became my new family when I was overseas and people I could confide in. So I really leaned on people like that, especially during deployments that were 7, 8 months. You come home and, at least for me, I missed my platoon mates. And even now that it’s been many, many years since my deployments, I still keep in touch with my platoon mates and I miss them. I think it was very positive and helpful to have the same group of people, whom I loved like family, around me. Annals: Hypothetically, how many weeks, months, or years do you expect or hope to spend in space between now and the end of your career? JK: I don’t know what I expect. But as much time in space that actually makes a positive difference, that’d be great. What percentage of my life? I don’t know. My wife might not like this answer, but maybe 10%, 25%. I don’t know. I mean, that’s not really a number I thought of much. Annals: But we’re talking about months, years. JK: Yeah, absolutely. I would certainly look forward to the opportunity to be able to spend months and years in space, to be able to make a difference. Annals: How many people who enter the astronaut program spend any time in space? JK: It’s a high number. I think it’s most. Annals: As an academic emergency physician, I have to “pimp” you while I have the chance. If you could only have 3 oral medications to take to Mars, what would they be? JK: Well, acetaminophen. I take that back, not acetaminophen because that would just be for pain. I’ll just deal with the pain. I’ll need a broad-spectrum oral antibiotic. And I think I would need a steroid, for life-threatening edema. Hmm. I don’t know. I guess maybe aspirin. Annals: Yes. That’s the correct answer! Aspirin. Mortality benefit for myocardial infarction, plus strokes, transient ischemic attacks. As far as the oral antibiotic, probably doxycycline or sulfamethoxazole-trimethoprim maybe. But no antiemetics. Does anything give you nausea? JK: This is funny, being in the Navy. But the first trip out on a boat always made me feel nauseated. It always took me a few hours to get over that, which was bad because on many training missions, I would be one of the first operators to assault a boat. So you have a guy that’s nauseated—not like debilitating nausea. But definitely I get a little bit seasick on the first ride. Annals: Who is your favorite astronaut? JK: It’s a tie between John Glenn and Neil Armstrong. Annals: Favorite space book? JK: The most recent one I read was a book called Halo: Reach, which is about the same video game series. And the author, Eric Nylund, wrote a spectacular space battle. I don’t know if that’s my favorite space book, but definitely a good one. Annals: Favorite space movie? JK: That’s easy. It’s Gattaca. But I like that movie not because it’s a space movie but because I think, and people might disagree, it’s the best underdog story ever, possibly even better than Rocky, which people will probably disagree with. But that’s why I love the movie. Annals: Worst space movie? JK: The one with John Travolta [Battlefield Earth]. I couldn’t finish it. Annals: Star Wars or Star Trek? JK: I am a Star Wars fan. Annals: It’s a fact that humans will either go extinct on Earth or outlive this fragile planet and explore the galaxy. Which is more likely, extinction or exploration? JK: I’m a pretty optimistic person. I believe in humanity. So I’m going to say exploration. Annals: The GomerBlog wants to know how you’ll diagnose anything in space without a computed tomography scanner. JK: Funny! Annals: Richard Nguyen on EM Docs on Facebook asked whether SEAL training helped with residency. JK: Definitely. The obvious area is teamwork, working in small teams, and really getting to know your team and what people’s strength and weaknesses are. What was good for me, in the teams, was people never hesitate to give you some constructive criticism, feedback, because everyone is depending on you to be a really good operator, because their lives depend on it. I think the same goes for emergency medicine, where patients’ lives really depend on your acumen of medicine. So being able to take that constructive criticism and feedback during medical school is something that I really crave. I always love the opportunity to get better. What better way to improve yourself than to hear what you didn’t do well? Annals: Which is harder, Navy SEAL training or residency? JK: They’re both difficult, in very different ways. Certainly, SEAL training was more stressful, mentally and physically. Residency training was stressful in that I was trying to balance raising a family and living in a high-cost-of-living area and go to a job that demanded a lot from me. I think it’s hard to measure the two. Special Warfare training was harder for me. Annals: I do want to say for our readers that, when I asked you that question, you had to pause and think about it for a second. JK: [laughs] Yes.